Preoperative Inferior Mesenteric Artery Embolization before Endovascular Aneurysm Repair: Decreased Incidence of Type II Endoleak and Aneurysm Sac Enlargement with 24-month Follow-up

Ward, Thomas J.; Cohen, Stuart; Fischman, A.; Kim, Edward; Nowakowski, F.; Ellozy, Sharif H.; Faries, Peter L.; Marin, Michael L.; Lookstein, R.

doi:10.1016/j.jvir.2012.09.022

Cited by 98 publications

(81 citation statements)

References 31 publications

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“…Therefore, persistent endoleaks are strongly associated with sac expansion. Ward et al (14) reported that preoperative embolization of the inferior mesenteric artery was associated with lower incidences of type II endoleaks and aneurysm sac enlargement. However, based on our data, we are unable to predict which types of type II endoleaks are important in terms of sac expansion or require preprocedural or intraprocedural embolization to minimize the risk of late sac expansion.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is difficult to predict sac expansion and persistent endoleak before performing EVAR. Although intraoperative intrasac thrombin injection and prophylactic embolization of aortic branches such as the inferior mesenteric artery and lumbar artery are reported to reduce the incidence of type II endoleak, the efficacy and clinical benefit of these procedures in terms of late postoperative aneurysm shrinkage have not been fully evaluated (12)(13)(14)(15). Therefore, the purpose of this study was to identify the risk factors associated with late aneurysmal sac expansion after EVAR to determine possible indications for intrasac embolization and prophylactic embolization of aortic branches.…”

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confidence: 99%

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Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair

Nakaï

Ikoma²,

Sato³

et al. 2015

Diagn Interv Radiol

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Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair CARDIOVASCULAR IMAGINGORIGINAL ARTICLE PURPOSE We aimed to identify the risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair (EVAR). METHODSWe retrospectively reviewed contrast-enhanced computed tomography (CT) images of 143 patients who were followed for ≥6 months after EVAR. Sac expansion was defined as an increase in sac diameter of 5 mm relative to the preoperative diameter. Univariate and multivariate analyses were performed to identify associated risk factors for late sac expansion after EVAR from the following variables: age, gender, device, endoleak, antiplatelet therapy, internal iliac artery embolization, and preprocedural variables (aneurysm diameter, proximal neck diameter, proximal neck length, suprarenal neck angulation, and infrarenal neck angulation). RESULTSUnivariate analysis revealed female gender, endoleak, aneurysm diameter ≥60 mm, suprarenal neck angulation >45°, and infrarenal neck angulation >60° as factors associated with sac expansion. Multivariate analysis revealed endoleak, aneurysm diameter ≥60 mm, and infrarenal neck angulation >60° as independent predictors of sac expansion (P < 0.05, for all). CONCLUSIONOur results suggest that patients with small abdominal aortic aneurysms (<60 mm) and infrarenal neck angulation ≤60° are more favorable candidates for EVAR. Intraprocedural treatments, such as prophylactic embolization of aortic branches or intrasac embolization, may reduce the risk of sac expansion in patients with larger abdominal aortic aneurysms or greater infrarenal neck angulation.T he aim of endovascular abdominal aortic aneurysm repair (EVAR) is to prevent rupture of an abdominal aortic aneurysm (AAA) by depressurizing the aneurysm and excluding it from the systemic circulation using a stent-graft. Aneurysmal sac reduction is a reliable marker for the long-term prognosis after EVAR. Although most aneurysmal sacs shrink after EVAR, some sacs continue to expand. A relationship between aneurysm size and endoleaks was previously reported (1, 2). Most type II endoleaks spontaneously disappear over time, but 10%-25% persist for more than six months after EVAR (3-6). Persistent endoleaks with aneurysmal sac expansion are at high risk of rupture because of the continuously elevated intra-aneurysmal pressure and require a second intervention, such as embolization (7-11). However, it is difficult to predict sac expansion and persistent endoleak before performing EVAR. Although intraoperative intrasac thrombin injection and prophylactic embolization of aortic branches such as the inferior mesenteric artery and lumbar artery are reported to reduce the incidence of type II endoleak, the efficacy and clinical benefit of these procedures in terms of late postoperative aneurysm shrinkage have not been fully evaluated (12)(13)(14)(15). Therefore, the purpose of this study was to identify the risk factors associated with late...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair

Nakaï

Ikoma²,

Sato³

et al. 2015

Diagn Interv Radiol

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“…30 Others have supported a more aggressive approach with intervention in all cases, 31 or they have even proposed preoperative embolization of aortic side branches to prevent a type II endoleak. 32, 33 Insufficient information concerning each subclass of type II endoleaks most likely accounts for the diverse management tactics for type II endoleaks. The 4D-flow analysis showed the flow pattern (ie, the flow direction and phase shift) and measured the blood flow volume and velocity of each endoleak-associated branch vessel.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Analysis of Endoleaks After Endovascular Abdominal Aortic Aneurysm Repair by Using 4-Dimensional Flow-Sensitive Magnetic Resonance Imaging

Sakata

Takehara

Katahashi

et al. 2016

Circ J

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Background: An endoleak is a common complication of endovascular abdominal aortic aneurysm repair (EVAR), and it can be associated with aneurysmal growth. This pilot study used 4-dimensional flow-sensitive magnetic resonance imaging (4D-flow) to assess the hemodynamics of different types of endoleaks (I-IV). Methods and Results:Magnetic resonance angiography, 4D-flow, and computed tomography angiography (CTA) were performed in 31 patients after nitinol-based stent-graft deployment. With 4D-flow, the 3D streamlines of endoleaks appear as integrated traces along the instantaneous velocity vector field that are color-coded according to the local velocity magnitude of the leak. The 4D-flow analysis identified endoleaks in 18 patients (58.1%), whereas CTA identified endoleaks in 13 patients (41.9%). The 4D-flow analysis created a characteristic image of each type of endoleak. Among patients with endoleaks, 4D-flow identified concomitant multiple endoleaks in 7 (39%) patients, and it further differentiated type II endoleaks from type IIa endoleaks (to-and-fro biphasic flow pattern from a branch vessel) and from type IIb endoleaks (monophasic flow pattern with a connection between the inflow and outflow branches). Conclusions:The 4D-flow analysis was more sensitive than CTA for detecting an endoleak, and it could subclassify type II endoleaks. In addition, 4D-flow differentiated between concomitant endoleak types in a single patient. (Circ J 2016; 80: 1715 -1725

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“…Pre-procedural imaging can be used to determine whether prophylactic embolization of the IMA may be warranted. Ward et al demonstrated that ancillary embolization of the IMA reduced the incidence of aneurysm sac enlargement, secondary procedures, and endoleak at 24 months post-EVAR (28). Likewise, a recent systematic review demonstrated the technical success of IMA embolization is high and may be warranted in patients with an IMA >3 mm in the prevention of type II endoleaks (29).…”

Section: Imamentioning

confidence: 99%

Repair of abdominal aortic aneurysms: preoperative imaging and evaluation

Pisimisis

Sheth

2018

Cardiovasc. Diagn. Ther.

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Imaging is a critical component of the pre-procedure evaluation and planning of endovascular aneurysm repair (EVAR). Imaging is the mainstay for proper assessment of procedural candidacy, relevant vascular anatomy, device selection, and surgical approach. Computed tomography angiography (CTA) has long been considered the preferred modality for pre-operative imaging and evaluation prior to EVAR.Recently, advances in image quality and software technology have further enhanced the proceduralist's ability to plan and perform EVAR. In this review, we highlight the current state of the art to provide interventionalists a contemporary assessment of the available tools for pre-operative imaging and evaluation prior to EVAR.

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Preoperative Inferior Mesenteric Artery Embolization before Endovascular Aneurysm Repair: Decreased Incidence of Type II Endoleak and Aneurysm Sac Enlargement with 24-month Follow-up

Cited by 98 publications

References 31 publications

Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair

Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair

Hemodynamic Analysis of Endoleaks After Endovascular Abdominal Aortic Aneurysm Repair by Using 4-Dimensional Flow-Sensitive Magnetic Resonance Imaging

Repair of abdominal aortic aneurysms: preoperative imaging and evaluation

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